I recently visited my optometrist to discuss Lasik, and while in his office we scheduled the surgery with his suggested surgeon at another location (he claims I have large pupils which necessitate the best of surgeons). Apparently, my optometrist will perform pre-surgery and post-surgery appointments, and I'll only see the surgeon on the day of my surgery. Also, I am to pay the surgeon one flat fee.

My question is - doesn't this present a conflict of interest for the refering optometrist? He could suggest a surgeon based entirely on the fees he receives from the surgeon for the post-operative care (and could include any kickback they wanted).

My wavefront lasik with intralase will cost $6400, clearly above prices quoted by other well-known centers (~$5300). It does appear my surgeon is highly regarded, and i'm not too worried about the money itself, but the optometrist/surgeon relationship concerns me.

Of course Lasik comanagement can be a conflict of interest, but not necessarily and not always. In the best-case comanagement has the advantage of two professionals trained in different areas of health care who coordinate efforts and check each other's work to provide the best possible care. In the worst-case it is a way to pay someone for a referral.

Comanagement has been around as long as there has been more than one healthcare provider. The paramedics who arrive on the scene of an accident are comanaging care with the hospital physician and staff. Even if you go to the office of an ophthalmologist (surgeon) for Lasik there will be technicians and staff who will provide some of the preoperative and postoperative care. If you live in an area where a surgeon is not readily available, comanagement may be the best alternative,

What I recommend is that you visit at least two more Lasik providers including one that does not do comanagement. Listen to the diagnosis and recommendations of each. If everyone is saying the same thing, then select the delivery method with which you are most comfortable.